Page:EB1911 - Volume 08.djvu/814

 on after each meal, or only after certain meals, and they may arise irrespective of the kind of food taken, or only after certain articles of diet. As in most of such cases the food is long retained in the stomach, it is apt to undergo fermentive changes, one of the results of which is the accumulation of gases which cause flatulence and eructations of an acid or foul character. Occasionally quantities of hot, sour, tasteless or bitter fluid—pyrosis—or mouthfuls of half-digested food, regurgitate from the stomach. Temporary relief may be obtained when another meal is taken, but soon the uncomfortable sensations return as before. The appetite may be craving or deficient, or desirous of abnormal kinds of food. The tongue registers the gastric condition with great delicacy:—a pasty white fur on the tongue is considered a sign of weakness or atony of the digestive tract; a clean pointed tongue with large papillae, and rather red at the edges and tip, is a sign of gastric irritation; and a pale flabby tongue suggests the need of stimulating treatment. Constipation is more common in the chronic forms of dyspepsia, diarrhoea in the acute.

Numerous disagreeable and painful sensations in other parts are experienced, and are indeed often more distressing than the merely gastric symptoms. Pains in the chest, shortness of breathing, palpitation, headache, giddiness, affections of vision, coldness of the extremities, and general languor are common accompaniments of dyspepsia; while the nervous phenomena are specially troublesome in the form of sleeplessness, irritability, despondency and hypochondriasis.

As regards treatment only a few general observations can be made. The careful arrangement of the diet is a matter of first importance. Quantity must be regulated by the digestive capabilities of the individual, his age, and the demands made upon his strength by work. There is little doubt that the danger is in most instances on the side of excess, and the rule which enjoins the cessation from eating before the appetite is satisfied is a safe one for dyspeptics. Due time, too, must be given for the digestion of a meal, and from four to six hours are in general required for this purpose. Long fasts, however, are nearly as hurtful as too frequent meals. Of no less importance is the kind of food taken, and on this point those who suffer from indigestion must ever exercise the greatest care. It must be borne in mind that idiosyncrasy often plays an important part in digestion, some persons being unable to partake without injury of substances which are generally regarded as wholesome and digestible. In most cases it is found very helpful to separate the protein from the farinaceous food, and the more severe the dyspepsia the more thoroughly should this be done, only relaxing as the dyspepsia yields. No fluid should be drunk at meal-times, but from one to two tumblers of hot water should be drunk from an hour to an hour and a half before food. This washes any remnant of the last meal from the stomach, and also supplies material for the free secretion of saliva and gastric juice, thus promoting and accelerating digestion. The only exception to this is in the case of a dilated stomach, when it is wholly contra-indicated. With regard to mastication, Sir Andrew Clark’s rule is a very good one, and is more easily followed than the ideal theory laid down by Horace Fletcher, according to whom any food is digestible if properly treated while still in the mouth. Clark’s rule is that as the mouth normally contains thirty-two teeth, thirty-two bites should be given before the food is swallowed. This, of course, is a practical doctor’s concession to human weakness. Mr Fletcher would train every one to “chew” till the contents of the mouth were swallowed by reflex action without deliberate act; and he applies this theory of mastication and salivation also to drinks (except water). Again, a lack of warmth being a source of dyspepsia, this should be attended to, the back of the neck, the front of the abdomen and the feet being the parts that require special attention. The feet should be raised on a stool, the ankles protected with warm stockings and a woollen “cummerbund” wound two or three times round the body. Experience has shown that in this complaint no particular kind of food or avoidance of food is absolutely to be relied on, but that in general the best diet is one of a mixed animal and vegetable kind, simply but well cooked. The partaking of many dishes, of highly-seasoned or salted meats, raw vegetables, newly-baked bread, pastry and confectionery are all well-known common causes of dyspepsia, and should be avoided. When even the simple diet usually taken is found to disagree, it may be necessary to change it temporarily for a still lighter form, such as a milk diet, and that even in very moderate quantity.

The employment of alcoholic stimulants to assist digestion is largely resorted to, both with and without medical advice. While it seems probable that in certain cases of atonic dyspepsia, particularly in the feeble and aged, the moderate administration of alcohol has the effect of stimulating the secretion of gastric juice, and is an important adjuvant to other remedies, the advantages of its habitual use as an aid to digestion by the young and otherwise healthy, is more than questionable, and it will generally be found that among them, those are least troubled with indigestion who abstain from it. Rest should be taken both before and after food, and general hygienic measures are highly important, since whatever improves the state of the health will have a favourable influence on digestion. Hence regular exercise in the open air, early rising and the cold bath are to be strongly recommended.

The medicinal treatment of dyspepsia can only be undertaken by a physician, but the following is a very brief résumé of the drugs he depends on to-day. Bicarbonate of soda with some bitter, as quassia, gentian or columba, is much in vogue as a direct gastric stimulant. In irritable dyspepsia some form of bismuth in solution or powder; and, to assist digestion through the nervous system, nux vomica and strychnine can be relied on. To give directly digestive material, hydrochloric acid, pepsin and rennet are prescribed in many forms, but where there is much vomiting ingluvin is more efficacious than pepsin. When farinaceous food is badly borne, diastase is helpful, given either before or with the meal. To prevent fermentation, phenol, creasote and sulpho-carbolate of soda are all extremely useful in skilled hands; and for intestinal decomposition and flatulent distension, bismuth salicylate with salol or -naphthol is much used. Cyllin, and charcoal in many forms, may be taken both for gastric and intestinal flatulence. But all these drugs, of proved value though they are, must be modified and combined to suit the special idiosyncrasy of the patient, and are therefore often worse than useless in inexperienced hands. The condition of the bowels must always have due attention.

 DYSTELEOLOGY, a modern word invented by Haeckel (Evolution of Man) for the doctrine of purposelessness, as opposed to the philosophical doctrine of design (Teleology).

 DZUNGARIA,, or , a former Mongolian kingdom of Central Asia, raised to its highest pitch by Kaldan or Bushtu Khan in the latter half of the 17th century, but completely destroyed by Chinese invasion about 1757–1759. It has played an important part in the history of Mongolia and the great migrations of Mongolian stems westward. Now its territory belongs partly to the Chinese empire (east Turkestan and north-western Mongolia) and partly to Russian Turkestan (provinces of Semiryechensk and Semipalatinsk). It derived its name from the Dsongars, or Songars, who were so called because they formed the left wing (dson, left; gar, hand) of the Mongolian army. Its widest limit included Kashgar, Yarkand, Khotan, the whole region of the Tʽien Shan, or Tian-shan, Mountains, and in short the greater proportion of that part of Central Asia which extends from 35° to 50° N. and from 72° to 97° E. The name, however, is more properly applied only to the present Chinese province of T’ien Shan-pei-lu and the country watered by the Ili. As a political or geographical term it has practically disappeared from the map; but the range of mountains stretching north-east along the southern frontier of the Land of the Seven Streams, as the district to the south-east of the Balkhash Lake is called, preserves the name of Dzungarian Range. 